Mia Health Care Guide

Has your health insurer denied payment for a doctor's recommended treatment? That doesn't have to be the end of the process. Stay tuned to learn more. Hello. I'm Therese Goldsmith,Insurance Commissioner for the State of Maryland. The Maryland Insurance Administration is a state agency that you can turn to if you have any questions about insurance. If your doctor or other healthcare provider tells you that you need a specific healthcare service and your health insurer or HMO disagrees, you have the right to appeal that decision. Here is how the appeal process works: Step 1: You will receive written notice from your health insurer or HMO denying either payment or authorization for the service. Step 2: The written notice will tell you that you can appeal the company's decision. Follow the instructions in that notice. If you would like help with the appeal process, contact the Health and Education Advocacy Unit of the Attorney General's office at 877-261-8807, and one of their staff members can help you. Step 3: If your health insurer or HMO upholds its original decision, then you have the right to file another appeal.The staff at the Health Education and Advocacy Unit can also help you prepare this appeal. In many cases you will file that second appeal with my agency, the Maryland Insurance Administration. The written notice you receive from the health insurer or HMO will explain to you where to file your appeal and the deadline for filing that appeal. Appeals that are filed with us must be in writing and include a signed consent form. Once we receive all the necessary medical records, we'll review your file and in some cases, we will send your case to an independent medical expert for review. In those cases, where we do not have jurisdiction, for example federal plans or self-funded plans, the Health Education and Advocacy Unit will explain to you the appeals process and where to file your appeal. Step 4: If we determine that the health insurer or HMO incorrectly denied your claim or request for authorization, the Maryland Insurnace Administration can order the health insurer or HMO to pay for the service. If you have a compelling reason that you cannot go through the health insurer's or HMO's internal appeal process first, you may be able to file your appeal directly with us. Learn more by visiting our website or by calling us at 1-800-492-6116. Thank you for watching.